title: Stent grafts for central venous occlusive disease in patients with ipsilateral hemodialysis access.
abstract: OBJECTIVE
  To assess long-term outcomes of stent grafts in patients with symptomatic central venous stenoses and occlusions ipsilateral to hemodialysis grafts or fistulas.
  
  
  METHODS
  The study included 52 of 55 consecutive patients with symptomatic stenoses of the central veins draining upper limb dialysis access grafts or fistulas treated with stent grafts. Indications for stent grafts were poor angioplasty results, rapid recurrence, or total occlusion. Endpoints were lesion patency and access patency following intervention. Mean follow-up was 25 months with a median of 24 months and 1.25 additional procedures per patient year. Patency rates were calculated using Kaplan-Meier analysis.
  
  
  RESULTS
  All stent grafts were successfully deployed. The lesion patency rates at 6, 12, 24, and 36 months after intervention were 60%, 40%, 28%, and 28%. The access patency rates at 6, 12, 24, and 36 months after intervention were 96%, 94%, 85%, and 72%. There was one major complication and no minor complications. In 40 patients (77%), the internal jugular vein confluence was covered by the stent graft. In five patients, the dialysis circuits became occluded, with no clinical sequelae in four; one patient was lost to follow-up. The contralateral brachiocephalic vein was covered in three patients (6%), preventing contralateral access construction in one patient.
  
  
  CONCLUSIONS
  Central vein stent graft placement in patients with hemodialysis access is associated with prolonged access patency. Coverage of major vein confluences, which occurred in 83% of the patients in this series, can compromise future access and should be avoided whenever possible by careful technique.
authors.affiliation: Department of Radiology, Shaare Zedek Medical Center, POB 3235, Jerusalem IL-91031, Israel. anthonyv@szmc.org.il
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Verstandig
authors.forename: Daniel
authors.initials: D
authors.lastname: Berelowitz
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Zaghal
authors.forename: Ilya
authors.initials: I
authors.lastname: Goldin
authors.forename: Oded
authors.initials: O
authors.lastname: Olsha
authors.forename: Bashar
authors.initials: B
authors.lastname: Shamieh
authors.forename: Vladimir
authors.initials: V
authors.lastname: Shraibman
authors.forename: David
authors.initials: D
authors.lastname: Shemesh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: PTA; percutaneous transluminal angioplasty